Citation Nr: 21062834 Decision Date: 10/12/21 Archive Date: 10/12/21 DOCKET NO. 17-24 010 DATE: October 12, 2021 REMANDED Entitlement to a compensable evaluation for residuals, puncture wound of the left palm thenar eminence is remanded. Entitlement to an increased rating in excess of 20 percent for service-connected median nerve injury, left upper limb, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from September 1998 to September 2003. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2012 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to a compensable evaluation for residuals, puncture wound of the left palm thenar eminence is remanded. 2. Entitlement to an increased rating in excess of 20 percent for service-connected median nerve injury, left upper limb, is remanded. The matter first appeared before the Board in January 2019 at which time the issue was remanded to obtain private treatment records, including from Middle Georgia Medical Associates and a VA examination to determine whether the Veteran's left-hand symptoms, including pain, numbness, tingling and difficulty gripping and holding, are related to his in-service left hand puncture wound. Initially, the Board notes that during the course of the appeal, the Veteran was granted service connection at a separate rating for median nerve injury, left upper limb at a 20 percent rating after the Veteran underwent a VA in-person examination in October 2019. Here, the Board has included the disability rating evaluation as an issue. The Board next notes that the most recent Supplemental Statement of the Case (SSOC) that adjudicated the Veteran's claims for a compensable evaluation of service-connected residuals, puncture wound of the left palm thenar eminence and an increased rating in excess of 20 percent for service-connected median nerve injury, left upper limb was issued in July 2020. Subsequently, relevant VA generated treatment records were associated with the claims file, including from February 2011 to June 2020 as well as additional private treatment records. No additional SSOC has been issued. The Board notes that any pertinent evidence submitted by a claimant or his representative after an appeal is certified to the Board is subject to initial review by the Board unless the Veteran explicitly requests RO consideration. See 38 U.S.C. § 7105. However, as such provision pertains only to Veteran submitted evidence, neither the Veteran nor the Veteran's representative submitted a waiver for VA generated evidence, only an August waiver of the full 30 days to respond to the SSOC is of record. Therefore, the Board may not consider the additional VA generated evidence associated with the claims file after the July 2020 SSOC in the first instance. Moreover, the Board is also remanding the matter for the reason noted below. 38 C.F.R. § 20.1305. In this case, the Board is unable to determine the severity level of the condition. At the time of the October 2019 examination, the examiner diagnosed the Veteran with residuals, puncture wound left palm thenar eminence. The examiner noted that the Veteran has two scars on the extremity and the scars that are painful, described as tingling and burning. The examiner reported a one by 0.1-centimeter scare and a 2 centimeter by 0.1-centimeter scar of the left upper extremity. The examiner found that the scars were without underlying tissue damage of approximate total area of 0.3 centimeters squared. The examiner noted that the scars were not unstable or without frequent loss of covering of skin or due to burns. The examiner opined that the Veteran's scar impacts his ability to work in that he has handling and fingering limitations of the left upper extremity. The examiner noted that the Veteran is right hand dominant. Here, the Board notes that the examiner found two painful scars that were not unstable. The examiner indicated that even though past EMG/NVC findings are non-contributory for a neuropathy, this does not lessen the Veteran's symptoms due to the reduced sensitivity of this diagnostic test. Here, the Board notes that the examination report did not indicate the severity level of the median nerve injury, left upper limb, specifically no indication was made as to whether the level of symptomatology of the condition is of mild, moderate or severe. As such, the Board finds remand is warranted to assess the current severity level of the condition. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination with an appropriate clinician to assess the current severity of his service-connected left upper limb extremity neuritis, including whether the condition is of a mild, moderate or severe severity level. The entire claims file, including a copy of the remand, must be made available to the examiner. Perform all necessary testing. All findings and conclusions should be set forth in a report. The examiner is further asked to opine as to: (i) Whether the Veteran's residuals, puncture wound of the left palm thenar eminence or median nerve injury, left upper limb condition manifested as pain, weakness, fatigability or incoordination that significantly limited functional ability, and (ii) Whether the Veteran experienced any flare-ups, and, if so, whether his pain during flare-ups limited his functional ability. If feasible, these opinions should be expressed in the terms of the degree of any additional range of motion loss due to pain during flare-ups. If the examiner cannot provide this opinion without resort to speculation, this must be based on a limitation of knowledge in the medical community at large and not a limitation - whether based on lack of expertise, insufficient information, or unprocured testing - of the individual examiner. 2. The RO should then readjudicate the issues on appeal in light of the evidence associated with the claims file after the July 2020 SSOC, including, with consideration of any other potential application of other Diagnostic Codes and the possibility of separate ratings for distinct manifestations for the claims on appeal. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Q. Alli, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.